As the Calories Churn (Episode 3): The Blame Game

We learned that there were some significant changes in those 40 years. We saw dramatic increases in vegetable oils, grain products, and poultry—the things that the 1977 Dietary Goals and the 1980 Dietary Guidelines told us to increase. We saw decreases in red meat, eggs, butter, and full-fat milk—things that our national dietary recommendations told us to decrease. Mysteriously, what didn’t seem to increase much—or at all—were SoFAS (meaning “Solid Fats and Added Sugars”) which, as far as the 2010 Dietary Guidelines for Americans are concerned, are the primary culprits behind our current health crisis. (“Solid Fats” are a linguistic sleight-of-hand that lumps saturated fat from natural animal sources in with processed partially-hydrogenated vegetables oils and margarines that contain transfats; SoFAS takes the trick a step further, by being not only a dreadful acronym in terms of implying that poor health is caused by sitting on our “sofas,” but by creating an umbrella term for foods that have little in common in terms of structure, biological function or nutrition.)

Around the late 70s or early 80s, there were sudden and rapid changes in America’s food supply and food choices and similar sudden and rapid changes in our health. How these two phenomena are related remains a matter of debate. It doesn’t matter if you’re Marion Nestle and you think the problem is calories or if you’re Gary Taubes and you think the problem is carbohydrate—both of those things increased in our food supply. (Whether or not the problem is fat is an open debate; food availability data points to an increase in added fats and oil, the majority of which are, ironically enough, the “healthy” monounsaturated kind; consumption data points to a leveling off of overall fat intake and a decrease in saturated fat—not a discrepancy I can solve here.) What seems to continue to mystify people is why this changed occurred so rapidly at this specific point in our food and health history.

Personally responsible or helplessly victimized?

At one time, it was commonly thought that obesity was a matter of personal responsibility and that our collective sense of willpower took a nosedive in the 80s, but nobody could ever explain quite why. (Perhaps a giant funk swept over the nation after The Muppet Show got cancelled, and we all collectively decided to console ourselves with Little Debbie Snack Cakes and Nickelodeon?) But because this approach is essentially industry-friendly (Hey, says Big Food, we just make the stuff!) and because no one has any explanation for why nearly three-quarters of our population decided to become fat lazy gluttons all at once (my Muppet Show theory notwithstanding) or for the increase of obesity among preschool children (clearly not affected by the Muppet Show’s cancellation), public health pundits and media-appointed experts have decided that obesity is no longer a matter of personal responsibility. Instead the problem is our “obesogenic environment,” created by the Big Bad Fast Processed Fatty Salty Sugary Food Industry.

Even though it is usually understood that a balance between supply and demand creates what happens in the marketplace, Michael Pollan has argued that it is the food industry’s creation of cheap, highly-processed, nutritionally-bogus food that has caused the rapid rise in obesity. If you are a fan of Pollanomics, it seems obvious that food industry—on a whim?—made a bunch of cheap tasty food, laden with fatsugarsalt, hoping that Americans would come along and eat it. And whaddaya know? They did! Sort of like a Field of Dreams only with Taco-flavored Doritos.

As a result, obesity has become a major public health problem.

Just like it was in 1952.

Helen Lee in thought-provoking article, The Making of the Obesity Epidemic (it is even longer than one of my blog posts, but well worth the time) describes how our obesity problem looked then:

“It is clear that weight control is a major public health problem,” Dr. Lester Breslow, a leading researcher, warned at the annual meeting of the western branch of the American Public Health Association (APHA). At the national meeting of the APHA later that year, experts called obesity “America’s No. 1 health problem.”

The year was 1952. There was exactly one McDonald’s in all of America, an entire six-pack of Coca-Cola contained fewer ounces of soda than a single Super Big Gulp today, and less than 10 percent of the population was obese.

In the three decades that followed, the number of McDonald’s restaurants would rise to nearly 8,000 in 32 countries around the world,sales of soda pop and junk food would explode — and yet, against the fears and predictions of public health experts, obesity in the United States hardly budged. The adult obesity rate was 13.4 percent in 1960. In 1980, it was 15 percent. If fast food was making us fatter, it wasn’t by very much.

Then, somewhat inexplicably, obesity took off.”

It is this “somewhat inexplicably” that has me awake at night gnashing my teeth.

And what is Government going to do about it?

I wonder how “inexplicable” it would be to Ms. Lee had she put these two things together:

(In case certain peoples have trouble with this concept, I’ll type this very slowly and loudly: I’m not implying that the Dietary Guidelines “caused” the rise in obesity; I am merely illustrating a temporal relationship of interest to me, and perhaps to a few billion other folks. I am also not implying that a particular change in diet “caused” the rise in obesity. My focus is on the widespread and encompassing effects that may have resulted from creating one official definition of “healthy food choices to prevent chronic disease” for the entire population.)

In a similar fashion, the 1977 Dietary Goals were the culmination of concerns about obesity that had begun decades before, joined by concerns about heart disease voiced by a vocal minority of scientists led by Ancel Keys. Declines in red meat, butter, whole milk and egg consumption had already begun in response to fears about cholesterol and saturated fat that originated with Keys and the American Heart Association—which used fear of fat and the heart attacks they supposedly caused as a fundraising tactic, especially among businessmen and health professionals, whom they portrayed as especially susceptible to this disease of “successful civilization and high living.” The escalation of these fears—and declines in intake of animal foods portrayed as especially dangerous—picked up momentum when Senator George McGovern and his Select Senate Committee created the 1977 Dietary Goals for Americans. It was thought that, just as we had “tackled” smoking, we could create a document advising Americans on healthy food choices and compliance would follow. But issue was a lot less straightforward.

To begin with, when smoking was at its peak, only around 40% of the population smoked. On the other hand, we expect that approximately 100% of the population eats.

In addition, the anti-smoking campaigns of the 1960s and 1970s built on a long tradition of public health messages—originating with the Temperance movement—that associated smoking with dirty habits, loose living, and moral decay. It was going to be much harder to fully convince Americans that traditional foods typically associated with robust good health, foods that the US government thought were so nutritionally important that in the recent past they had been “saved” for the troops, were now suspect and to be avoided.

Where the American public had once been told to save “wheat, meat, and fats” for the soldiers, they now had to be convinced to separate the “wheat” from the “meat and fats” and believe that one was okay and the others were not.

To do this, public health leaders and policy makers turned to science, hoping to use it just as it had been used in anti-smoking arguments. Frankly, however, nutrition science just wasn’t up to the task. Linking nutrition to chronic disease was a field of study that would be in its infancy after it grew up a bit; in 1977, it was barely embryonic. There was little definitive data to support the notion that saturated fat from whole animal foods was actually a health risk; even experts who thought that the theory that saturated fat might be linked to heart disease had merit didn’t think there was enough evidence to call for dramatic changes in American’s eating habits.

The scientists who were intent on waving the “fear of fat” flag had to rely on observational studies of populations (considered then and now to be the weakest form of evidence), in order to attempt to prove that heart disease was related to intake of saturated fat (upon closer examination, these studies did not even do that).

Nutrition epidemiology is a soft science, so soft that it is not difficult to shape it into whatever conclusions the Consistent Public Health Message requires. In large-scale observational studies, dietary habits are difficult to measure and the results of Food Frequency Questionnaires are often more a product of wishful thinking than of reality. Furthermore, the size of associations in nutrition epidemiological studies is typically small—an order of magnitude smaller than those found for smoking and risk of chronic disease.

But nutrition epidemiology had proved its utility in convincing the public of the benefits of dietary change in the 70s and since then has become the primary tool—and the biggest funding stream (this is hardly coincidental)—for cementing in place the Consistent Public Health Message to reduce saturated fat and increase grains and cereals.

There is no doubt that the dramatic dietary change that the federal government was recommending was going to require some changes from the food industry, and they appear to have responded to the increased demands for low-fat,whole grain products with enthusiasm. Public health recommendations and the food fears they engendered are (as my friend James Woodward puts it) “a mechanism for encouraging consumers to make healthy eating decisions, with the ultimate goal of improving health outcomes.” Experts like Kelly Brownell and Marion Nestle decry the tactics used by the food industry of taking food components thought to be “bad” out of products while adding in components thought to be “good,” but it was federal dietary recommendations focusing above all else on avoiding saturated fat, cholesterol, and salt that led the way for such products to be marketed as “healthy” and to become acceptable to a confused, busy, and anxious public. The result was a decrease in demand for red meat, butter, whole milk and egg, and an increase in demand for low-saturated fat, low-cholesterol, and “whole” grain products. Minimally-processed animal-based products were replaced by cheaply-made, highly-processed plant-based products, which food manufacturers could market as healthy because, according to our USDA/HHS Dietary Guidelines, they were healthy.

The problem lies in the fact that—although these products contained less of the “unhealthy” stuff Americans were supposed to avoid—they also contained less of our most important nutrients, especially protein and fat-soluble vitamins. We were less likely to feel full and satisfied eating these products, and we were more likely to snack or binge—behaviors that were also fully endorsed by the food industry.

Between food industry marketing and the steady drumbeat of media messages explaining just how deadly red meat and eggs are (courtesy of population studies from Harvard, see above), Americans got the message. About 36% of the population believe that UFOs are real; only 25% believe that there’s no link between saturated fat and heart disease. We are more willing to believe that we’ve been visited by creatures from outer space than we are to believe that foods that humans have been eating ever since they became human have no harmful effects on health. But while industry has certainly taken advantage of our gullibility, they weren’t the ones who started those rumors, and they should not be shouldering all of the blame for the consequences.

Fixing it until it broke

Back in 1977, we were given a cure that didn’t work for diseases that we didn’t have. Then we spent billions in research dollars trying to get the glass slipper to fit the ugly stepsister’s foot. In the meantime, the food industry has done just what we would expect it to do, provide us with the foods that we think we should eat to be healthy and—when we feel deprived (because we are deprived)—with the foods we are hungry for.

We can blame industry, but as long as food manufacturers can take any mixture of vegetable oils and grain/cereals and tweak it with added fiber, vitamins, minerals, a little soy protein or maybe some chicken parts, some artificial sweeteners and salt substitutes, plus whatever other colors/preservatives/stabilizers/flavorizers they can get away with and still be able to get the right profile on the nutrition facts panel (which people do read), consumers–confused, busy, hungry–are going to be duped into believing what they are purchasing is “healthy” because–in fact–the government has deemed it so. And when these consumers are hungry later—which they are very likely to be—and they exercise their rights as consumers rather than their willpower, who should we blame then?

There is no way around it. Our dietary recommendations are at the heart of the problem they were created to try to reverse. Unlike the public health approach to smoking, we “fixed” obesity until it broke for real.

Very cool. Thanks so much for this. It seems that in our efforts to condemn SFA, we seem to have avoided looking at these relationships. I have even heard talk (in certain circles) that the negative effects of transfats on health could be a proxy for the effects of LA.

I found this statement very interesting: “In contrast, changes in total energy consumption, and calories from grains, beef, all fish and seafood, eggs, dairy or vegetables were not significantly correlated with increasing rates of obesity.” Hmmmmm.

Thanks again. I am motivated to continue blogging if only so that my brilliant readers will share these sorts of things with me.

when is the media(who bascially influence and control everyones life) going to tell the truth and not vilify saturated fat, red meat, butter, eggs, coconut oil etc, why does everyone hang their hat on an ancel keys study in the 50’s and not embrace new REAL un manipulated evidence? the low fat FAD has caused more deaths than anything, it astounds me. it is painfully obvious that obesity, heart disease, cardio disease diabetes, etc, is the result of hydrogenated oils, sugar, processed refined carbs and artificial sweeteners, not FAT!

You sound like me on a day without yoga. It is sort of a facepalm situation. It seems obvious that we need to rethink our dietary recommendations, but the barriers to change are numerous, subtle, and well funded. With people like Michael Pollan, who are popular with the public, using only as his references people like Marion Nestle and Walter Willett who are popular with the nutrition mainstream, and with people like Dean Ornish presiding over health coverage in media outlets like HuffPo, there is a closed circle of information that is hard to get through. But the tide is turning. The trick is how to turn the tide in a way that is truly beneficial for those whose voices are not represented by either Michael Pollan or most of the paleo / whole foods / low-carb community.

BRAVO, BRAVO
“About 36% of the population believe that UFOs are real; only 25% believe that there’s no link between saturated fat and heart disease. We are more willing to believe that we’ve been visited by creatures from outer space than we are to believe that foods that humans have been eating ever since they became human have no harmful effects on health”

I’m afraid that this sounds like I am making fun of the gullibility of Americans , but it really highlights the success of the PR campaign against saturated fat. Of course, I do wonder why we were so gullible.

I prefer the term credulity – the trait of believing in the honesty and reliability of others. Quote:

(Sir Francis) Bacon identifies four different classes of idol. Each arises from a different source, and each presents its own special hazards and difficulties.

1. The Idols of the Tribe.

These are the natural weaknesses and tendencies common to human nature. Because they are innate, they cannot be completely eliminated, but only recognized and compensated for. Some of Bacon’s examples are:

Our senses – which are inherently dull and easily deceivable. (Which is why Bacon prescribes instruments and strict investigative methods to correct them.)
Our tendency to discern (or even impose) more order in phenomena than is actually there. As Bacon points out, we are apt to find similitude where there is actually singularity, regularity where there is actually randomness, etc.
Our tendency towards “wishful thinking.” According to Bacon, we have a natural inclination to accept, believe, and even prove what we would prefer to be true.
Our tendency to rush to conclusions and make premature judgments (instead of gradually and painstakingly accumulating evidence). http://www.iep.utm.edu/bacon/#SH2f

All begin life naive and trusting. Some eventually learn to investigate, ask questions, question answers, and formulate opinions. Most don’t, apparently.

Great quote. Thanks so much for sending that. I think in the nutrition we suffer especially from finding order and patterns where there are none, partly I think, because Magic Food Rules seem to be such a handy way to cheat death and disease. There is no doubt that there is a great deal of shamanism in our approach to food in America, emphasis on the “sham.”

Modern vegetable oils certainly are part of the problem – highly processed corn oil, soybean oil, canola oil – what mischief do they cause with metabolism? Contributing to insulin resistance, I suspect. Combine them with refined carbs missing important nutrients and all the flavor tricks of the food industry and you are sure to be unsatisfied and want to eat more. So was it the Dietary Guidelines, or did they just happen to coincide with the industry discovering their tricks to get folks to eat more, while they took advantage of the cholesterol/sat. fat phobia that was developing. I’m sure a good many of the obese (think those beer bellies) have little concern for cholesterol and saturated fat, even though now many folks think they are food enemy #1.
Just my rambling thoughts!

Excellent post! I’ve enjoyed all 3 episodes of As the Calories Churn. In addition to the seriously flawed USDA’s Food Pyramid, to further complicate making truly “healthy” food choices, consumers are also faced with product endorsements from medical associations such as the American Heart Association’s seal of approval on the package. The AHA doesn’t go around slapping their check mark on foods as a public service; it costs the food manufacturers money. Food is BIG business and the AMA’s blessing is a great marketing tools, especially when the fear of heart disease is near and dear to so many. Plenty of foods may be a better choice than those with the seal, it’s just that the company hasn’t paid for it. You don’t see the check mark on fresh broccoli or kale, now do you? But either would seem a much better choice over packaged cereal for heart health.

You make an excellent point. The AHA and other public health advocacy organizations are very much complicit in the maintenance of recommendations that have had–if anything–adverse affects on the health of the public. This public health advocacy stuff is big business and groups like the AHA, ADA, and AND are multi-million dollar corporations (or in the case of the AHA, billion) and, as with Big Food, what is good for the business end of the organization is not always good for the part of the organization that interacts with the public.

A more subtle point is that our Nutrition Facts Label is a similar sort of “check mark” on foods. It promotes a particular unproven health claim and there are huge financial implications for food manufacturers that come with what is on that label. And–you don’t find it on kale or broccoli.

I read as much of it as I could stand. She takes a rambling ride around so many common tropes of nutrition and public health, I really got tired of it.

I think she really overstates the comparisons between the antismoking campaigns and the anti-obesity efforts.

And she really latches on to Breslow as if he had all the answers. I agree with her emphasizing Breslow’s focus on a “larger vision of health”, and “the capacity for full living”, but what Breslow and Lee seemingly don’t understand or have not experienced properly, is that the focus on diet is warranted as the first step because a poor diet impairs your ability and desire to follow other healthful and health-promoting activities like exercise and good sleep.

“Healthy Smoking Guidelines for Americans and or ChooseMyTobacco.gov” LOL. I don’t find many parallels between Big Tobacco and Big Food myself, the primary issue being that everyone has to eat. From there, everything else pretty much falls apart.

To take this argument back more to individual cases (and ultimately it will come down to case histories of people becoming obese or curing obesity), what also changed in 1977 was the advice given to people who, having noticed that they were starting to get pudgy, decided to do something about it. From low-carb or protein-sparing diets, the mainstream of advice changed so that people were expected to lose weight on high-carb, low-fat diets. So the most vulnerable people were exposed to the worst advice, to a higher rate of failure. The assumption that lowering cholesterol would go with weight control was another aspect of this sloppy thinking.

Excellent point. According to Harvey Levenstein (whose Fear of Food I am thoroughly enjoying), despite the AMA’s opposition to using foods to prevent disease (everyone who wanted to prevent disease should be under a doctor’s care, according to them), the low-fat approach to curing obesity and preventing heart disease was so relentlessly pushed by the medical journals and so enthusiastically embraced by the public that “Physicians were overwhelmed by this assault, both from their waiting rooms and their professional journals. A low fat, low cholesterol diet became as automatic in their treatment as a polite goodbye.”

Fab post! That said, I reserve the right to continue to blame industry ;). Bad food guidelines may well have been the tipping point, but it’s not just bad foods that can be marketed as “healthy” that are problematic.

Thanks! Industry doesn’t get a free pass from me either (more to come), but I often wonder what would happen to our intake of less healthy food if we all started out (the day, our lives) with adequate nutrition.

Great post – really thought-provoking and you make a strong case. I do think this:

it seems obvious that food industry—on a whim?—made a bunch of cheap tasty food, laden with fatsugarsalt, hoping that Americans would come along and eat it. And whaddaya know? They did! Sort of like a Field of Dreams only with Taco-flavored Doritos.

is oversimplifying the Pollanite argument a bit though; isn’t it more likely that the food industry (being populated by reasonably intelligent people) noticed that people like fatsugarsalt, started adding it to their products, and the supply/demand developed more organically? I don’t think anyone’s claiming that we went from 0 to Doritos Locos Tacos overnight…at least, that’s not what I got from reading The Omnivore’s Dilemma.

But in any case, I definitely agree with the main thrust of your argument.

Thanks! Yes, I am oversimplifying, maybe just a bit. But fatsugarsalt have been around for a very long time, and the folks who manufacture food products have been making very tasty foods for a very long time. The Charles Chips guy used to deliver to your house & Oreos of today are a pathetic shadow of the ones made with lard back in the day. The key to Pollan’s argument is the “cheap” as much as the “tasty.” In fact, in Omnivore’s Dilemma, he puts a rather fine point on it: “When food is abundant and cheap, people will eat more of it and get fat.” He doesn’t even mention “tasty.”

Until we realized that we couldn’t explain the rise in obesity from the “personal responsibility” angle and had to start relying on blaming the food industry, the idea that people would eat MORE food because it was cheaper would have been considered just a little wacky. It was understood that the demand for food is fairly stable, that people don’t eat more food when food is cheap, they eat better food (which used to mean more meat and other animal products) and/or they spend their money on things less essential than food. In fact, also in Omnivore’s Dilemma, Pollan quotes a farmer whose notions on farm policy he seems to largely agree with (how me manages to completely disregard this quote is beyond me): “But the demand for food isn’t elastic; people don’t eat more just because food is cheap.”

What Pollan also disregards is the cost–social and economic–of obesity. As my buddy James Woodward explains it, if we assume that someone who is overweight or obese is acting rationally (and we should), then reducing intake should have the dual benefit of both reducing food expenditure and improving health, not to mention reducing the social stigmas associated with overweight and obesity.

Excellent post. It really says something to me that the different food industries in those nutrition guidelines and food pyramids have lobbyists in Washington…and that fact that food is an industry now…

Thanks! Food has been an “industry” for a while, but in the past, the government was more likely to spend its time preventing, rather than encouraging, misleading claims about “health” on labels. But when the official Nutrition Facts Panel is itself a misleading health claim, we are in a different world.

Perhaps part of the problem is that neither government nor academia were equipped to deal with the onslaught of technological food when it made it’s début. It takes a visionary like Ross Hume Hall to frame the problem clearly. Excerpt from the Introduction to “Food for Nought”:

“Nourishment of the American populace has undergone a startling transformation since World War II. A highly individual system of growing and marketing food has been transformed into a gigantic, highly integrated service system in which the object is not to nourish or even to feed, but to force an ever-increasing consumption of fabricated products. This phenomenon is not peculiar to the American scene and occurs in every industrialized country. The United States, however, has progressed furthest in the transformation. Man can never be more than what he eats, and one would expect that a phenomenon with such profound effects on health and wellbeing as a radically changed system of supplying nourishment would be thoroughly documented and assessed by the scientific community. Such is not the case. The transformation has gone unmarked by government agencies and learned bodies. Government agencies, recipients of the public trust, charged with protecting and improving the public’s food, operate as if the technology of food fabrication rested in pre-World War II days. Scientific bodies, supported by public funds and charged with assessing and improving the public’s health, ignore completely the results of contemporary methods of marketing food…Failure to monitor and to appreciate the results of rapidly moving technology produces a brutal effect that forms the central theme of this book. Technology founded on mechanistic laws clashes head on with the processes of a natural world which adheres to very different laws. Modern industry, ignoring these biologic laws, molds and manipulates natural processes to suit and to promote its own mechanistic and economic goals.”

So why doesn’t government do its job? Perhaps because of institutional arrangements among government, academia, and the industrial food system. Corporations can always be counted on to do whatever it takes to protect the supply chain. Politicians instinctively protect commerce. And academia? Best to not get started on that. Let’s just say academics who don’t adequately inform themselves ought to be regarded as derelict.

It is fascinating to me that this perspective comes even before the rapid rise in obesity and diabetes. I have another book from that era, Fat of the Land, that discusses similar issues.

So if these issues were raised 35 years ago, what happened? I do wonder sometimes if our national fixation on reducing saturated fat and cholesterol (and on trying to prove that such reductions were of benefit) distracted us from the real problems at hand.

Thanks so much for sharing this quote. Excellent stuff. Hmmm, maybe I should get a copy?